Critical Issues in the Assessment of Child Sexual Abuse

This article explores the feasibility of using standardized psychometric methods in the initial stages of an investigation of child sexual abuse; methods that are less intrusive and therefore less damaging to children and their families. We review the complex conceptual and research issues that arise from attempts to assess the many-sided aspects of child sexual maltreatment. Among those considered in both the clinical and research spheres are problems of definition and diagnosis; limitations of clinical interviews, and a variety of direct and indirect psychological instruments used for investigating sexual maltreatment and risk assessment; the inadequacies of experimental designs; and also the political, practical, and ethical restraints that hinder research in this area. It is argued that there is insufficient evidence based on controlled studies or standardized normative tests to advocate any simple, unidimensional methodology for the screening task. However, recommendations are put forward for the cautious, conjoint use of several procedures in a multidimensional approach to assessing child sexual abuse. Suggestions are also made for future research and development.     

9970名中学生心理素质的研究

对北京市随机抽取的９９７０名中学生进行自编的《中学生心理素质测验》的测试,结果表明：（１）总体而言,中学生的心理素质水平良好。（２）年级越低,心理素质水平越高,年级越高,心理素质水平越低。（３）初中生的心理素质水平好于高中生。（４）在男女性别差异上,年级越低,男女差异越大,年级越高,差异越小。其中,男生在智力和情绪因子上心理素质水平好于女生,女生在注意力和道德感因子上心理素质水平好于男生。在对初中与高中的男女性别考验中也得到了一致的结论。     

The psychopathology of anorexia nervosa: A factor analytic investigation

To examine the psychopathology of anorexia nervosa, behavioral assessment measures sampling a wide range of relevant constructs were collected on 150 women diagnosed as having anorexia nervosa. The data were subjected to an exploratory factor analysis using maximum-likelihood estimation and oblique rotation. Five factors were extracted, which were titled Fasting and Restrictive Eating, Depression, Anxiety, and Negative Self-image, Bulimic Behaviors, Fear of Fatness/Body Image Disturbance, and Impulsive Behavior/Post-Traumatic Response. Discriminate function analysis suggested that, other than the bulimic behaviors factor, the Impulsive Behavior/Post-Traumatic Response factor best discriminated between bulimic and restrictor subtypes of anorexics. These data suggest that the underlying dimensions of anorexia nervosa are very similar to those of bulimia nervosa. The findings also have implications for the multidimensional assessment and treatment of anorexia nervosa as well as conceptual models of the disorder.     

The nature of sexual reinforcement.

Sexual reinforcers are not part of a regulatory system involved in the maintenance of critical metabolic processes, they differ for males and females, they differ as a function of species and mating system, and they show ontogenetic and seasonal changes related to endocrine conditions. Exposure to a member of the opposite sex without copulation can be sufficient for sexual reinforcement. However, copulatory access is a stronger reinforcer, and copulatory opportunity can serve to enhance the reinforcing efficacy of stimulus features of a sexual partner. Conversely, under certain conditions, noncopulatory exposure serves to decrease reinforcer efficacy. Many common learning phenomena such as acquisition, extinction, discrimination learning, second-order conditioning, and latent inhibition have been demonstrated in sexual conditioning. These observations extend the generality of findings obtained with more conventional reinforcers, but the mechanisms of these effects and their gender and species specificity remain to be explored.     

Perfectionism and Sexual Satisfaction in Intimate Relationships

This study sought to provide information on the relations between trait perfectionism and perfectionistic self-presentation and sexual satisfaction in married couples. A sample of 74 married or cohabiting couples were recruited from the community to participate in the study. They completed measures of perfectionism, perfectionistic self-presentation, sexual satisfaction, dyadic adjustment, and depression. The results showed that the interpersonal dimensions of trait perfectionism were negatively related to general sexual satisfaction and sexual satisfaction with the partner for both husbands and wives. After partialing out marital satisfaction and depression, the husband's sexual satisfaction was significantly negatively correlated with his own socially prescribed perfectionism and with his wife's ratings of other-oriented perfectionism. The wife's satisfaction was significantly negatively correlated both with her husband's socially prescribed perfectionism and with her own socially prescribed perfectionism, other-oriented perfectionism, and perfectionistic self-presentation. Regression analyses suggest that the wife's other-oriented perfectionism is a unique predictor of her general lower sexual satisfaction and her husband's lower satisfaction with her contribution to the sexual relationship. Overall, the findings suggest that perfectionistic expectations have an important role to play in sexual satisfaction in married couples.     

Sexual and Physical Abuse Among Adolescent Girls with Disruptive Behavior Problems

We examined the prevalence and age of onset of physical and sexual abuse in a clinic-referred sample of adolescent girls, as well as differences in diagnoses and symptoms among abused and non-abused girls. Forty-nine girls (aged 13–17 years) with disruptive behavior were interviewed along with their primary caretaker. Data were gathered through both a structured interview with the girl and her parent, as well as self and parent-report questionnaires. Findings indicated that the prevalence of Conduct Disorder (CD) and Major Depression were higher for abused girls. Somatoform Pain Disorder was significantly less likely for physically abused girls, compared to girls who were both physically and sexually abused. Of CD symptoms, truancy was twice as high for the physically and sexually abused group, compared to the prevalence for non-abused girls. Internalizing symptoms were also highest for the dual abuse group. Onset graphs show that the onset of sexual abuse usually occurred at an earlier age than the onset of physical abuse. Abused girls showed an earlier age of onset of CD symptoms. Results indicated that the experience of combined types of abuse is associated with a poorer psychiatric prognosis.     

Reducing HIV risk-associated sexual behavior among african american adolescents: Testing the generality of intervention effects

This randomized controlled trial tested the effects of a theory-based culture-sensitive HIV risk-reduction intervention among 496 inner-city African American adolescents (mean age = 13 years) and examined the generality of its effects as a function of the facilitator's race and gender and the gender composition of the intervention group. Adolescents who received the HIV risk-reduction intervention expressed more favorable behavioral beliefs about condoms, greater self-efficacy, and stronger condom-use intentions postintervention than did those who received a control intervention on other health issues. Six-month follow-up data collected on 93% of the adolescents revealed that those who received the HIV risk-reduction intervention reported less HIV risk-associated sexual behavior, including unprotected coitus, than did their counterparts in the control condition. Self-reported sexual behavior and changes in self-reported behavior were unrelated to scores on a standard measure of social desirability response bias. There was strong evidence for the generality of intervention effects. Moderator analyses testing eight specific interaction hypotheses and correlational analyses indicated that the effects of the HIV risk-reduction intervention did not vary as a function of the facilitator's race or gender, participant's gender, or the gender composition of the intervention group. This research was supported in part by grants from the National Institute of Child Health and Human Development (R01-HD24921), the National Institute of Mental Health (R01-MH45668), and the Social Science and Humanities Research Council of Canada. The authors gratefully acknowledge the contributions to this research of Margaret Bleier, Daria Boccher-Lattimore, Nancy L. Moore, Tatiana Perrino, Paul Pintella, and Fran Rosenfeld and the helpful suggestions of Isabel Fernandez, Caryn Lerman, and Ann O'Leary regarding an earlier version of this article.     

The Professional Autonomy of the Medical Doctor in Italy

This contribution deals with the issue of the professional autonomy ofthe medical doctor. Worldwide, the physician's autonomy is guaranteedand limited, first of all, by Codes of Medical Ethics. InItaly, the latest version of the national Code of MedicalEthics (Code 1998) was published in 1998 by the Federation ofprovincial Medical Associations (FnomCeO). The Code 1998acknowledges the physician's autonomy regarding the scheduling, thechoice and application of diagnostic and therapeutic means, within theprinciples of professional responsibility. This responsibility has tomake reference to the following fundamental ethical principles:(1) the protection of human life; (2) the protection of thephysical and psychological health of the human being; (3) therelief from pain; (4) the respect for the freedom and the dignityof the human person, without discrimination; (5) an up-to-datescientific qualification (Art. 5). The authors underline that autonomyis an anthropological – and consequently ethical –characteristic of the human person. Different positions on autonomy inbioethics (individualistic, evolutionistic, utilitarian andpersonalistic models) are explained. The relation between theprofessional autonomy of the physician and the autonomy of the patientand of colleagues is discussed. In fact, the medical doctor isobliged: (1) to respect the fundamental rights of the person,first of all his/her life; (2) to ensure the continuity of thecare, even if he can only relieve the patient's suffering; (3) tomaintain, except under certain circumstances, professional secrecy andconfidentiality regarding patients and their medical records. Moreover,the physician cannot deny the patient correct and appropriateinformation. He/she should not perform any diagnostic or therapeuticactivity without the informed consent of the patient and the medicaldoctor must give up medical treatment in case of documented refusal ofthe individual. Furthermore, the medical doctor has the right to raiseconscientious objections if he/she is requested to perform medicalactions that are contrary to his/her conscience or medical opinion,unless this attitude would seriously and immediately harm the patient.Regarding the relationships with colleagues, the physician is obliged tosolidarity, mutual respect, and care of sick colleagues. Finally, theauthors discuss the Italian legislation affecting the physician'sprofessional autonomy: (1) the SSN health care Acts; (2) theso-called Charter for Public Health Care Services; (3) the Acts onprivacy; (4) Good Clinical Practice.     

Sexual Risk-Taking Behaviors Among Adolescents with Severe Emotional Disturbance

We investigated the sexual risk-taking behaviors of adolescents with severe emotional disturbance (SED). Subjects (N = 70) were clients of the South Carolina Continuum of Care. Information on sexual intercourse, sexual risk-taking, aggressive behaviors, substance use, and suicidal behavior was gathered using a modified version of the US Centers for Disease Control and Prevention self-report Youth Risk Behavior Survey. Forty-two percent of each race-gender group reported first intercourse before age 13, except for African American females at 63%. Seventy-five to 79% of all race-gender groups reported first sexual intercourse by age 18. Drinking alcohol before age 13 and carrying a weapon in the past 30 days were associated with first intercourse before age 13. Youth reporting first intercourse between ages 13 and 18 were about 12 times more likely to report suicide ideation than those youth who reported never having sexual intercourse. Youth with SED reporting first intercourse before age 13 appear to have an increased risk for unintended pregnancy and for contracting a sexually transmitted disease compared to youth with SED reporting first intercourse after age 13.